Research question

What were the trends in utilization, outcomes and practices in assisted reproductive technology (ART) in Africa between 2013 and 2017?

Design

Cycle-based data and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres.

Results

During the 5-year period, 153,917 ART procedures were reported from 73 centres in 18 countries. ART utilization remained low in all countries and years. Autologous fresh ART was by far the most common intervention, with little change in the clinical pregnancy rate (CPR) per aspiration (34.9% in 2013; 31.7% in 2017) and a consistent preponderance of young women. Oocyte donation represented less than 10% of reported procedures. Although the transfer of multiple embryos prevailed, elective single-embryo transfer (eSET) resulted in a CPR of 43.2% per transfer in fresh autologous cycles, which was notably higher compared with non-elective SET cycles (16.6%) and all dual embryo transfers (DET; 37.3%). Compared with eSET, elective DET further increased the CPR by less than 5% while raising the multiple delivery rate by 33.4%. The majority of multiples were born preterm. Many pregnancies were, however, lost to follow-up, compromising the delivery and birth outcome data.

Conclusion

ART monitoring has been successfully established in Africa although progress must continue. Although data are not yet representative, best evidence indicates low access to ART. Perinatal outcome supports eSET, but other social determinants responsible for multiple embryo transfers are important factors to consider. Efforts must be directed at improving pregnancy follow-up. Registry data are integral to the widening of access to high-quality ART in Africa.

中文翻译：

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非洲的辅助生殖技术：来自非洲 ART 网络和登记处的 5 年趋势分析。

研究问题

2013 年至 2017 年期间，非洲辅助生殖技术 (ART) 的使用、结果和实践趋势如何？

设计

基于周期的数据和回顾性汇总数据是从自愿参与的 ART 中心横断面收集的。

结果

在这 5 年期间，18 个国家/地区的 73 个中心报告了 153,917 例 ART 手术。所有国家和年份的 ART 使用率仍然很低。迄今为止，自体新鲜 ART 是最常见的干预措施，每次穿刺的临床妊娠率 (CPR) 几乎没有变化（2013 年为 34.9%；2017 年为 31.7%），并且始终以年轻女性为主。卵母细胞捐赠占报告程序的不到 10%。尽管多胚胎移植盛行，但选择性单胚胎移植 (eSET) 在新鲜自体循环中每次移植的 CPR 为 43.2%，与非选择性 SET 循环 (16.6%) 和所有双胚胎移植相比，该值明显更高(DET; 37.3%)。与 eSET 相比，选择性 DET 进一步使 CPR 提高了不到 5%，同时将多次分娩率提高了 33.4%。大多数多胞胎早产。然而，许多怀孕未能进行随访，从而影响了分娩和出生结果数据。

结论

ART 监测已在非洲成功建立，但必须继续取得进展。尽管数据尚不具有代表性，但最好的证据表明获得 ART 的机会很少。围产期结果支持 eSET，但其他负责多个胚胎移植的社会决定因素是需要考虑的重要因素。必须努力改善妊娠随访。注册数据对于扩大非洲高质量 ART 的获取是不可或缺的。